Patient Rights and POA

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Hi everyone,

Any advice/responses on this topic would be appreciated!

I recently had a patient who was admitted for a GI bleed. The patient was AO x 4; however, she had her mother as her POA. The patient was in need of a blood transfusion, initially, she was refusing and not wanting to sign the consent for a blood transfusion. After informing the doctor of the patients refusal, the doctor stated that the blood transfusion could still be started by having the POA sign the consent.

Am I crazy, or is this incorrect? From my experience, I always thought that the POA only took over when the patient was unable to make these decisions on their own? The patient was oriented, but did have a long history of mental health disorders. Ultimately, the patient decided to sign the consent on her own, but I am still left wondering, was I wrong for believing that the patient still had the right to refuse a transfusion????

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The client has the right to make her/his own decisions unless/until s/he is unable to, at which point the POA authority kicks in. However, whether or not the client is "able" to make decisions is a medical decision, and the attending physician is the person who gets to decide that the client is unable to make (appropriate) decisions.

There is a lot more involved in determining whether an individual has the capacity to make informed decisions about healthcare than simply whether the person is oriented.

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I think that if I had been in your position I would call my state Board of Nursing and ask their advice on how to proceed in the situation you described.

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elkpark said:
The client has the right to make her/his own decisions unless/until s/he is unable to, at which point the POA authority kicks in. However, whether or not the client is "able" to make decisions is a medical decision, and the attending physician is the person who gets to decide that the client is unable to make (appropriate) decisions.

There is a lot more involved in determining whether an individual has the capacity to make informed decisions about healthcare than simply whether the person is oriented.

Explain, please.

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morte said:
Explain, please.

Frankly, I've explained this so many times on this site I'm tired of doing it. There are lots of existing threads.

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elkpark said:
Frankly, I've explained this so many times on this site I'm tired of doing it. There are lots of existing threads.

I am slightly aghast at your rude response. I was not questioning your statement, more looking for expansion of your thoughts for the OP.

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Didn't mean to sound rude, just tired. Your response to my initial post was rather abrupt, for that matter.

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Specializes in Med/Surge, Psych, LTC, Home Health.

A patient can be alert, oriented, know where they are, what day it is, but still believe that the blood they are given is going to turn them into a vampire. In which case, they would need a POA to make the determination that they need the transfusion. Perhaps? I mean, you get what I'm saying?

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elkpark said:
Didn't mean to sound rude, just tired. Your response to my initial post was rather abrupt, for that matter.

I did say please.

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NurseCard said:
A patient can be alert, oriented, know where they are, what day it is, but still believe that the blood they are given is going to turn them into a vampire. In which case, they would need a POA to make the determination that they need the transfusion. Perhaps? I mean, you get what I'm saying?

Precisely, had one recently that could name every staff member that came into his room, but wanted us to do things that were illogical. He wanted me to go wake his mother up, his mother is no longer with us. I asked the patient how old he was, the patient, he slide by that one, and went on to the next staff member.... Yes, he could say where he was and properly id the persons around him, but he was in some form of alternate reality.

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Specializes in Psych (25 years), Medical (15 years).

I am really confused. I thought I had a handle on when the POA assumes responsibility over a Patient's care thing.

Not being competent to make decisions is a legal process that needs to be ruled on by a Judge, or so I thought. I also thought POA's could only step in where the Patient is found to be incompetent, or unable to make their own decisions, as in the case of unconsciousness.

A Physician having the total power to rule on an Individual's competency just doesn't sound right to me.

Please. Do elaborate.

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I think state laws vary regaring this, but yes, generally-speaking a physician has been allowed historically to make an evaluation of competency. A judge can, too, when warranted.

What confuses me sometimes (in real time) is whether a POA has been made out to be used in time of need (such that I may "have a POA" that is not currently being utilized because I myself am competent at this particular point in time) vs. having a POA that is currently being utilized - meaning, the person designated as POA is indeed currently acting in that role.

That's confusing. As is the fact that a POA can be made out/prepared "ahead of time," but then someone must determine whether or not current conditions meet the legal requirements for the POA to be utilized. It seems to me like this may be what happened in the OP. There was a POA prepared ahead of time, and the physician said essentially, 'yes, the patient is not competent to make this decision and therefore we will utilize the POA that has already been set up, and allow the POA to make this decision.'

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